| Jerome Toothtown Pllc | |
|
1555 S Lincoln Ave Jerome ID 83338-6136 | |
| (208) 539-9876 | |
| Not Available |
| Full Name | Jerome Toothtown Pllc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1555 S Lincoln Ave, Jerome, Idaho |
| Authorized Official Name and Position | Jesse Ivie (MANAGER) |
| Authorized Official Contact | 2085399876 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jerome Toothtown Pllc 1555 S Lincoln Ave Jerome ID 83338-6136 Ph: () - | Jerome Toothtown Pllc 1555 S Lincoln Ave Jerome ID 83338-6136 Ph: (208) 539-9876 |
| NPI Number | 1568100857 |
|---|---|
| Provider Enumeration Date | 05/25/2022 |
| Last Update Date | 05/25/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568100857 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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